WHAT IS A REIMBURSEMENT SPECIALIST?
A reimbursement specialist is a combination between a coder and a financial analyst. The coding background allows the analysis to be done with more comprehension and recognition of impact.
This capacity also encompasses the skillset to analyze the billing process to determine appropriateness in payments. This analysis is made against contract review, chargemaster setup, pricing methodology, contract negotiation support, and market analysis.
Another function of a reimbursement specialist is the review of reimbursement tools of the practice. That is, review and update of all forms, primarily the superbills (charge tickets) and the ABN forms.
WHAT IS A MEDICAL AUDITOR ?
A medical auditor is a coder capable of reviewing medical documentation and the assigned procedure and diagnosis codes to determine if those coding assignments are appropriate. This determination is based on ethical coding guidelines and the application of CMS/AMA Documentation Guidelines.
A medical auditor has the skillset to create an audit report to report findings to the provider/executive management. The findings are used as a basis for making recommendations to be implemented as improvements in the operation. This provides the organization with the tools to reduce their risk.
WHAT IS A MEDICAL AUDITOR REIMBURSEMENT SPECIALIST?
A medical auditor reimbursement specialist encompasses all skills in the above two categories. Additionally, this individual possesses the skills to communicate findings in a presentation style. Further, findings and their interpretation are made in well written reports with citations.
As a medical auditor reimbursement specialist one has the know-how and recognition to influence policy and thus impact an organization's navigation through the tumultuous healthcare changes making them manageable.
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